Positive airway pressure (PAP) has been used since the 1930s to improve oxygenation, increase lung volumes and reduce venous return. More recently, PAP has been identified as an effective method of splinting airway during expiration, improving collateral ventilation, increasing response to inhaled bronchodilators, and aiding secretion clearance in patients with cystic fibrosis and chronic bronchitis. A range of devices, administration techniques, and evidence supporting their clinical use is explored, suggesting that PAP is equivalent to postural drainage in the clearance of secretions. PAP produced by threshold and fixed orifice resistors generate different characteristic flow, and airway and esophageal pressure patterns that may contribute to different physiologic effects. Further clinical studies are required to better understand the effects of these differences.
American Association for Respiratory Care. AARC Clinical Practice Guideline: Use of positive airway pressure adjuncts to bronchial hygiene therapy. Respir Care1993;38(5):516–521.
RickstenSE, BengtssonA, SoderbergC, ThordenM, KvistH.Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Chest1986;89(6):774–781.
4.
AndersenJB, KlausenNO. A new mode of administration of nebulized bronchodilator in severe bronchospasm. Eur J Respir Dis Suppl1982;119:97–100.
5.
Frischknecht-ChristensenE, NorregaardO, DahlR.Treatment of bronchial asthma with terbutaline inhaled by conespacer combined with positive expiratory pressure mask. Chest1991;100(2):317–321.
6.
KacmarekRM, DimasS, ReynoldsJ, ShapiroBA. Technical aspects of positive end expiratory pressure (PEEP). Part 1. Physics of PEEP devices. Respir Care1982;27(12):1478–1489.
7.
MahlmeisterMJ, FinkJB, HoffmanGL, FiferLF. Positive-expiratory-pressure mask therapy: theoretical and practical considerations and a review of the literature. Respir Care1991;36(11):1218–1230.
8.
FinkJB. Bronchial hygiene and lung expansion. In: FinkJB, HuntGE, editors. Clinical practice in respiratory care. Philadelphia: Lippincott Williams & Wilkins; 1999.
9.
ThomanRL, StokerGL, RossJC. The efficacy of pursed-lips breathing in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis1966;93(1):100–106.
10.
PettyTL. Chronic obstructive pulmonary disease. New York: Marcel Dekker; 1978.
11.
PoultonEP, OdonDM. Left-sided heart failure with pulmonary oedema: its treatment with the "pulmonary plus pressure machine."Lancet1936;231:981–983.
12.
BarachAL, MartinJ, EckmanL.Positive pressure respiration and its application to the treatment of acute pulmonary edema and respiratory obstruction. Proc Am Soc Clin Invest1937;16:664–680.
13.
CheneyFW, HornbeinTF, CrawfordEW. The effect of expiratory resistance on the blood gas tensions of anesthetized patients. Anesthesiology1967;28(4):670–676.
GregoryGA, KittermanJA, PhibbsRH, TooleyWH, HamiltonWK. Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. N Eng J Med1971;284(24):1333–1340.
KatzJA. PEEP and CPAP in perioperative respiratory care. Respir Care1984;29(6):614–624; discussion 624–629.
18.
GarrardCS, ShahM.The effects of expiratory positive airway pressure on function residual capacity in normal subjects. Crit Care Med1978;6(5):320–332.
19.
AndersenJB, QvistH, KannT.Recruiting collapsed lung through collateral channels with positive end-expiratory pressure. Scan J Respir Dis1979;60(5):260–266.
20.
AndersenJB, JespersenW.Demonstration of intersegmental respiratory bronchioles in normal lungs. Eur J Respir Dis1980;61(6):337–341.
21.
BransonRD, HurstJM, DeHavenCB. Mask CPAP: state of the art. Respir Care1985;30(10):846–857.
22.
BransonRD. PEEP without endotracheal intubation. Respir Care1988;33(7):598–610.
23.
AndersenJB, OlesenKP, EikardE, JansenE, QvistJ.Periodic continuous positive airway pressure, CPAP, by mask in the treatment of atelectasis: a sequential analysis. Eur J Respir Dis1980;61:20–25.
24.
PontoppidanH.Mechanical aids to lung expansion in nonintubated surgical patients. Am Rev Respir Dis1980;122(5 Pt 2):109–119.
25.
CarlssonC, SondenB, ThylenU.Can postoperative continuous positive airway pressure (CPAP) prevent pulmonary complications after abdominal surgery?Intensive Care Med1981;7(5):225–229.
26.
MartinJG, ShoreS, EngelLA. Effect of continuous positive pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis1982;126(5):812–817.
27.
StockMC, DownsJB. Administration of continuous positive airway pressure by mask. Acute Care1983/84;10(3-4):184–188.
28.
StockMC, DownsJB, CorkranML. Pulmonary function before and after prolonged continuous positive airway pressure by mask. Crit Care Med1984;12(11):973–974.
29.
StockMC, DownsJB, CooperRB, LebensonIM, ClevelandJ, WeaverDE, . Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations. Crit Care Med1984;12(11):969–972.
30.
StockMC, DownsJB, GauerPK, AlsterJM, ImreyPB. Prevention of postoperative pulmonary complication with CPAP, incentive spirometry and conservative therapy. Chest1985;87(2):151–157.
31.
LindnerKH, LotzP, AhnefeldFW. Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest1987;92(1):66–70.
32.
CampbellT, FergusonN, McKinlayRGC. The use of a simple self-administered method of positive expiratory pressure (PEP) in chest physiotherapy after abdominal surgery. Physiotherapy1986;72:498–500.
GrothS, StafangerG, DirksenH, AndersenJB, FalkM, KelstrupM.Positive expiratory pressure (PEP mask) physiotherapy improves ventilation and reduces volume of trapped gas in cystic fibrosis. Bull Eur Physiopathol Respir1985;21(4):339–343.
35.
van der SchansCP, van der MarkTW, de VriesG, PiersDA, BeekhuisH, Dankert-RoelseJE, . Effect of positive expiratory pressure breathing in patients with cystic fibrosis. Thorax1991;46(4):252–256.
36.
van der SchansCP, de JongW, de VriesG, KaanWA, PostmaDS, KoeterGH, van der MarkTW. Effects of positive expiratory pressure breathing during exercise in patients with COPD. Chest1994;105(3):782–789.
37.
McIlwainePM, WongLT, PeacockD, DavidsonAG. Long-term comparative trial of conventional postural drainage and percussion versus positive expiratory pressure physiotherapy in the treatment of cystic fibrosis. J Pediatr1997;131(4):570–574.
38.
ReismanJJ, Rivington-LawB, CoreyM, MarcotteJ, WannamakerE, HarcourtD, LevisonH.Role of conventional physiotherpay in cystic fibrosis. J Pediatr1988;113(4):632–636.
